patrick.net

Dan8267 says

The phrase, "When there's more than one payer", should be your first clue that Medicare isn't a single payer system.

There are people who buy medicare supplemental insurance, but they are a tiny minority. Single Payer System means that everyone is eligible to be covered by that single payer (usually the government). It does not mean people would have no option of buying something else in addition to it. Heck, should the government cover cosmetic surgery or provide hookers and blows to you for your emotional health? If it doesn't, should it then outlaw cosmetic surgery and hookers and blows? and do you expect such enforcement would be effective anyway?

The whole fucking purpose of Medicare has nothing, nothing whatsofuckingever, to do with the purpose of single payer. How much clearer can I make it to you numbskulls?

If you think "single payer" means expanding Medicare to everyone, you are a fucking retard. Plain and simple.

Please do tell how would such a single-payer system be different from extending Medicare to everyone? Would you outlaw doctors who do not take Medicare? Would your single-payer cover every single conceivable medical operation? or do you have a death panel that not only refuses coverage but also carry out execution so the patient can't seek out-of-coverage care on their own expense?

Dan - I'm just confused by what you're saying. Even the quote from Medicare's website (that you gave above) refers to Medicare as a "payer". Insurance companies are payers, and Medicare is a payer since it uses payroll taxes (we all get hit by it) to fund the pay-out to providers if they perform a service for a covered person. This is one of the whole controversies that because Medicare pay-outs to providers are so low, providers end up over-charging private payers (or insurance companies) to make up for their losses.

Many retirees will get supplemental insurance as a secondary payer with Medicare being the primary payer. You can have a single payer system co-exist with private insurance (which is another payer), which is the way most other single payer systems operate. So, Medicare is, in essence, a single payer gov't system for people over certain age because EVERYONE that qualifies automatically gets it...it's universal.

Now, you may be referring to medical "coding" practices and making those universal so you create less confusion by following one standard maybe?

We may have to just agree to disagree unless you can explain where we're wrong on this.

dublin hillz says

Average american general practitioner makes almost $160,000 per year. Comparatively, Switzerland and Netherlands are under $120K, France about 95K, Finland about 70K,

No that is not what they "make". That's the PPP number which is so flawed as to be totally meaningless. It doesn't include things like half the hours, 6-8 weeks paid vacation, no student loans, 6 years school vs 8 years school.

Switzerland under 120k? I don't think so. http://www.mejobs.eu/en/hot-jobs/75 here's a recruiter offering 9-12k euro per month, 108-144 euro per year 146-195k us dollars. For 40 a hour week with 34 paid days off (7 weeks almost). That's base, call is paid on top of that. How many US gp's get 34 paid days off a year or put in 40 hours a week? That number would be zero. You want to check out the numbers for gp's in Canada? How about 250k+. http://www.overseasdoctorjobs.com/can/ How about Oz 250k city to 380k rural. http://www.gpjobsinaustralia.co.uk/more-info/getting-paid/

debyne says

I also think medical school is a complete racket with how much it costs, and they only allow in a very small number of elite. This often causes a shortage of doctors, which makes all the more advantageous for them to charge fee for service and make a ton of money. There's a lot going on as to why doctors are paid so much, and much of it is driven by themselves to protect their high salaries and elite status.

Then why is the US dead square in the middle of the OECD for doctors per capita grouped pretty closely with Japan, Canada, UK, and New Zealand. What doctor shortage are we talking about?

Reality says

You answered for yourself why single-payer system is a bad idea: the contractor (and everyone else put in that position) would just want more hookers and blows while putting in the least amount of work.

That is a reason why capitalists and corporations are bad. They always want to get the most wealth by doing the least amount of work.

Reality says

Competition is what makes people put in work in order to earn their way to hookers and blows. It is this work from someone else that we all need in order to keep living.

And there is no competition in the status quo either before or after the ACA. There is no market, free or in any other sense, in the current system. See this post.

If you really believe in markets, then you would be for single payer because no market, in any sense of the word, can exist without single payer. Single payer creates the health care market and the very competition you are advocating.

Why do so-called "free-market" advocates always promote the tearing down of acutal free markets? Sounds like lip service.

Reality says

There are people who buy medicare supplemental insurance, but they are a tiny minority. Single Payer System means that everyone is eligible to be covered by that single payer (usually the government).

Wrong again. Single payer is not insurance.

http://www.pnhp.org/facts/what-is-single-payer

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—[typically] a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system.

http://blogs.wsj.com/experts/2013/11/18/please-just-give-us-a-single-payer-system-already/

[B]ased on prices in other countries, where government payers can negotiate, the U.S. pays at least three times more than the rest of the world. This is one of many examples of the U.S.’ unsuccessful and fractured efforts to force our health-care system into a free market model, and the reasons health care now accounts for an unsustainable 18% of our GNP.

Like other systems where the buyer and seller have vastly different levels of information, and the stakes—life or death—are so high, health care does not respond to the typical equalizing constraints of the free market. So if I may make the operative word in this question “could,” (implying any fantasy change I dream up is actually possible), I opt for the ACA to adopt a single payer system. That payer need not be the government (though we trust them to run plenty of other life-saving and complex systems reasonably well, such as fire and police), but until we have a unified overseer and deliverer of this fundamental and necessary component of civilized society we will not be able to standardize either care or costs.

Call it Crazy says

You have to sign up for ANY insurance you get, does your Single Payer insurance fairy sign you up automatically???

debyne says

Dan - I'm just confused by what you're saying. Even the quote from Medicare's website (that you gave above) refers to Medicare as a "payer".

I guess I'm going to have to dumb this down even more. Give me time to reduce it to a Jesus-like parable the right can understand. I really don't get while it's so hard for the right to distinguish between nationalizing health care and using a single payer system. It's like the difference between a Boeing 747 and a banana.

Zak says

These are people who work basically without a life and little pay through 4
years of med school, then 4 or more years of residency AFTER 4 years of
undergrad college, with all the associated cost. Not one of these government
plans has given one shit about taking a bit of the burden of med students and
residents, or their associated loans, and your nose is all up in the ass of
these politicians talking bout the smell of roses , and they just want to ream
your butthole while you smile and tell em what a great job they are doing

That's the point, they wouldn't go through all these sacrifices if there were no meaningful payoff at the end. Why else would they go through the opportunity cost of foregone wages and intense studying? Do you think doctors are motivated by purely altruistic motives in united states? Do you believe that in certain cultures "becoming a doctor" is done out of desire to help others vs trying to climb a social food chain ladder? Your argument is extremely naive and short sighted.